Provider Demographics
NPI:1295180578
Name:EASTIN, MEREDITH N (PNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:N
Last Name:EASTIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5338 BRIAN CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4801
Mailing Address - Country:US
Mailing Address - Phone:405-227-4576
Mailing Address - Fax:
Practice Address - Street 1:1514 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3379
Practice Address - Country:US
Practice Address - Phone:318-549-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131336363LP0200X
LAAP09230363LP0200X
LARN142286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse